The Medicalization of Nordestinos : Public Health and Regional Identity in Northeastern Brazil, 1889-1930

In his 1927 annual report to the Pernambucan state legislature, Governor Estacio de Albuquerque Coimbra wrote that "the economic, intellectual, moral and civic value of the Nation and the State is shaped, with the expression of human activity, in the excellence of physical and moral robustness of its population." ¹ He believed that government was responsible for improving the condition of its citizens, and that "man, healthy or sick, . . . ought to fall under the knowing gaze of the Governments, preserving or restoring him to health, to benefit the Nation." Under Coimbra's administrations, the Pernambucan government inaugurated public health, public assistance, and education programs designed to improve the material and physical well-being of Pernambucan citizens. This was not an easy task; regional economic underdevelopment and perennial budget crises threatened government-sponsored social programs. While public health programs could be implemented and administered with relative ease in the state's capital of Recife, transportation problems and low population density made the extension of such services to the residents of the state's interior almost impossible. Despite these obstacles, public health programs and the physical well-being of the state's populations had become the single most important concern of the Pernambucan government by the mid 1920s, and the expectation of future economic development and social progress was tied to the development of effective public health programs.

Public health became increasingly important in northeastern Brazil in the 1910s due to growing local, national, and international interest in improving sanitary conditions in the region. In addition to services offered by the Pernambucan government, reformers and federal legislators created the national Rural Preventive Health Service (Serviço de Profilaxia Rural) as a response to increased knowledge of health conditions in the northeastern sertão, the arid interior of the region. The Rockefeller Foundation also played a role in developing public health services in the region, administering rural health posts for the treatment of ancylostomiasis, or hookworm disease, and mosquito control programs designed to eliminate yellow fever and malaria. Despite these efforts to improve public health conditions, Brazilian and foreign observers believed the Northeast to be one of the most unhealthy regions in the nation. ²

Pernambucan, national, and foreign government officials each had different understandings of the nature and causes of northeastern public health problems. ³ These conflicts reflected widely divergent opinions about the social and economic value of the Northeast and nordestinos, as inhabitants of the region were called. In the late nineteenth and early twentieth centuries, Pernambucan reformers and public health officials offered generally optimistic assessments of nordestinos' social and economic value. While nordestinos were unhealthy, officials believed that effective public health programs could control diseases and improve the populations of the region. Conversely, national and foreign public health officials' understandings were shaped by prevailing understandings of race and Brazilian national identity which constructed nordestinos as racially inferior to other Brazilians. ⁴ With few exceptions, while they believed that public health programs would improve social and economic conditions in the region, they also believed that nordestinos would never become the equals of Brazilians from more developed areas of the nation. These beliefs about the region and its peoples shaped political debates about public health throughout the 1910s and 1920s. At the same time, ideas about diseases and their long-term effects on nordestinos became an essential component of constructions of northeastern regional identity. By 1930, both northeastern and national reformers and politicians most often expressed their concerns about the region using the language of medicine and public health. While northeastern, national, and international public health officials at times disagreed about medical techniques and the management of public health campaigns, they agreed that the Northeast was the most unhealthy region in the nation.

The development of public health services in early twentieth century Brazil has received considerable attention from historians who...